Postoperative radiotherapy of the cervical carcinoma in elderly patients: Over 60 years

The purpose of the study was to analyze survival and late radiation effects according to performed surgery and radiation therapy in elderly patients. Between 1996-1997. year 44 patients with cervical carcinoma older then 60 years were treated with postoperative radiotherapy. Radiotherapy included external beam irradiation with TD 36-45 Gy in 18-22 fractions and endocavitar brachy-therapy with TD 28-35Gy in 4-5 fractions. We analyzed two groups of patients group I 29/44 (65,9%) had radical operation by Werthaim-Meigs vs group II 15/44 (34,1%) patients had standard operation. Median follow-up was 48 months. Survival for all patients was 70,43%. Late postirradiation effects in the gastrointestinal tract were 40,9% and in urinary tract 25% - in both groups. A larger percent of late postirradiation sequeles were on GIT in group I vs group II (44,8% vs 33,3%) and on UR tract also (31,03% vs 13,3%). The doses of external beam irradation were equalize in both groups, while brachytherapy regime 4xTD7,5Gy was more represent in group I. Late side effects and complications after postoperative radiotherapy are acceptable, but it is necessary to carry out randomized trials with different dose regime in brachytherapy.

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Nutritional status and energy expenditure in elderly patients with recent hip fracture during a 2-month follow-up

British Journal Of Nutrition ◽

10.1017/s0007114500000131 ◽

2000 ◽

Vol 83 (2) ◽

pp. 97-103 ◽

Cited By ~ 52

Author(s):

Elena Paillaud ◽

Phuong-Nhi Bories ◽

Jean-Claude Le Parco ◽

Bernard Campillo

Keyword(s):

Hip Fracture ◽

Energy Expenditure ◽

Nutritional Status ◽

Elderly Patients ◽

Energy Intake ◽

Normal Values ◽

Group Iii ◽

Group I ◽

Group Ii

A 2-month follow-up of nutritional status was performed in forty elderly patients with recent hip fracture. Patients were nutritionally assessed on admission to our rehabilitation unit (day 0), then monthly (day 30, day 60) by measurement of resting energy expenditure (REE), anthropometric, impedance and biological variables. Patients were defined as undernourished (n 13) or normally nourished (n 27) on the basis of mid-arm circumference (MAC) and triceps skinfold thickness (TST) measurements. Seven patients recovered a walking autonomy and were discharged from the hospital before day 30 (group I) whereas thirteen patients were discharged after day 30 (group II); twenty patients remained in the study at day 60 (group III). MAC and TST decreased in normally nourished patients from group III throughout the study whereas they did not change in group II or in undernourished patients from group III. REE values in relation to fat-free mass were increased compared with normal values and were similar in the three groups on day 0; they did not change during the study. Daily energy intake in relation to body weight was higher in group I and increased in group II and in undernourished patients from group III throughout the study. In contrast, it was below the recommended value at day 0 and it did not significantly improve in normally nourished patients from group III. Serum albumin, transthyretin and transferrin levels on day 0 were below reference intervals in the three groups. Albumin levels increased in group III throughout the study. Inflammatory proteins decreased in groups II and III, with C-reactive protein levels returning to normal values in group II by day 30 and in group III at day 60, while orosomucoid levels did not become completely normal over this period. Our findings indicate no improvement in nutritional status in undernourished patients after surgery for recent hip fracture, despite an adequate energy intake. An insufficient spontaneous energy intake for normally nourished patients was associated with a delayed favourable outcome resulting in a prolonged duration of hospitalization. A hypermetabolic state persisted during the 3 months after surgery.

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Comparative Assessment of Autogenous Cancellous Bone Graft and Bovine-Derived Demineralized Bone Matrix for Secondary Alveolar Bone Grafting in Patients With Unilateral Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211025197 ◽

2021 ◽

pp. 105566562110251

Author(s):

Vijay Kumar ◽

Vidya Rattan ◽

Sachin Rai ◽

Satinder Pal Singh ◽

Jai Kumar Mahajan

Keyword(s):

Bone Graft ◽

Iliac Crest ◽

Demineralized Bone Matrix ◽

Bone Matrix ◽

Volumetric Analysis ◽

Group I ◽

Alveolar Bone Grafting ◽

Group Ii ◽

Demineralized Bone

Objective: Comparison between bovine-derived demineralized bone matrix (DMBM) and iliac crest graft over long term for secondary alveolar bone grafting (SABG) in patients with unilateral cleft lip and palate (UCLP) in terms of radiological and clinical outcomes. Design: Prospective, randomized, parallel groups, double-blind, controlled trial. Setting: Unit of Oral and Maxillofacial Surgery, Oral Health Science Centre, Postgraduate Institute of Medical Education & Research, Chandigarh. Participants: Twenty patients with UCLP. Interventions: Patients were allocated into group I (Iliac crest bone graft) and group II (DMBM) for SABG. Outcomes were assessed at 2 weeks, 6 months, and then after mean follow-up period of 63 months. Outcomes Measures: Volumetric analysis of the grafted bone in the alveolar cleft site was done through cone beam computed tomography using Cavalieri principle and modified assessment tool. Clinical assessment was performed in terms of pain, swelling, duration of hospital stay, cost of surgery, alar base symmetry, and donor site morbidity associated with iliac crest harvesting. Results: Volumetric analysis through Cavalieri principle revealed comparable bone uptake at follow-up of 6 months between group I (70%) and group II (69%). Modified assessment tool showed no significant difference between horizontal and vertical bone scores over short- and long-term follow-up. In group II, there was higher cost of surgery, but no donor site morbidity unlike group I. Conclusions: Demineralized bone matrix proved analogous to iliac crest bone graft as per volumetric analysis over shorter period. However, although statistically insignificant, net bone volume achieved was lower than the iliac crest graft at longer follow-up.

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Platelet rich plasma versus extracorporeal shock wave therapy in patients with non-calcific supraspinatous tears

Egyptian Rheumatology and Rehabilitation ◽

10.1186/s43166-020-00020-7 ◽

2020 ◽

Vol 47 (1) ◽

Author(s):

Samah M. Alian ◽

Rabab S. Zaghlol ◽

Sahar S. Khalil

Keyword(s):

Shock Wave ◽

Outcome Measures ◽

Platelet Rich Plasma ◽

Extracorporeal Shock Wave Therapy ◽

Shock Wave Therapy ◽

Tendon Tear ◽

Extracorporeal Shock Wave ◽

Group I ◽

Group Ii

Abstract Background To compare the clinical efficacy of platelet rich plasma (PRP) subacromial injection and extracorporeal shock wave therapy (ESWT) on refractory non-calcific partial thickness supraspinatous tendon tear. Results Significant improvement in all outcome measures achieved in both groups at 4 weeks follow-up period (the end of treatment course) (P< 0.05). At 12 weeks follow-up period, group I, showed significant improvement in all outcome measures compared to baseline and group II; however, in group II, there was no significant difference compared to baseline; moreover, deterioration in the previous improvement was noticed. Conclusion Both PRP (group I) and ESWT (group II) are effective therapeutic methods in the management of refractory non-calcific partial thickness supraspinatous tendon tear; however, PRP (group I) has better long-term effects on both pain and function.

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RECURRENCE RATE AFTER REPEAT TRANSURETHRAL RESECTION AMONG PATIENTS WITH NEWLY DIAGNOSED T1 BLADDER CANCER

10.36106/ijar/7213765 ◽

2021 ◽

pp. 51-54

Author(s):

Md. Shafiqur Rahman ◽

Sanjeeb Bhakta Bista ◽

Md. Sayedul Islam ◽

A. S. M. Shafiul Azam ◽

Md. Shamim Hossain ◽

...

Keyword(s):

Bladder Cancer ◽

Recurrence Rate ◽

Transurethral Resection ◽

Tumor Recurrence ◽

Controlled Trial ◽

Intravesical Therapy ◽

Newly Diagnosed ◽

Group I ◽

Group Ii

Background: Transurethral resection of the bladder tumor (TURBT) is the cornerstone of diagnosis and TURBT followed by selective adjuvant intravesical chemotherapy or immunotherapy is the gold standard of treatment for the patients with non-muscle invasive bladder cancer (NMIBC). Even after complete resection of the tumor there is high risk of residual tumor and subsequent recurrence and progression of the disease. The recurrence of T1 tumor is found to be around 71 % within 5 years and High grade T1 lesions recur in more than 80% of the cases and progress in 50% of the patients within 3 years. Disease status at 3 months after initial resection is an important predictor of subsequent recurrence and progression. To assess the tumor recurrence rat Objective: e among patients with newly diagnosed T1 bladder cancer between repeat transurethral resection group and single TURBT group. Ra Type of study: ndomized controlled trial. Place of study: Department of urology, BSMMU, Dhaka, Bangladesh. This Randomi Materials And Methods: zed Controlled Trial was conducted in urology department of BSMMU, Dhaka, Bangladesh from February 2017 till September 2018. A total of 50 patients, diagnosed as a case of T1 bladder cancer and who fulll the selection criteria were randomly divided in two groups consisting of 25 patients in each group. After informed consent, repeat TUR was done after 4 weeks of the initial TURBT for only 22 patients in group I since 3 of the patients did not show up on the scheduled date of surgery. Whereas, repeat TUR was not done for other 25 patients in group II. All the patients in both the groups were further treated with intravesical therapy according to the histopathological report. The patients in both the groups were followed up at 3 months and 6 months of the initial intervention where detailed history was taken, relevant investigations were done and check cystoscopy was done. TURBT was done for recurrent tumors. Out of 22 patients in group I, 2 patients were excluded for follow up on the basis of repeat TUR ndings. Whereas in group II, 2 patients missed the follow up and one of them missed the normal scheduled dose of intravesical therapy. Hence, 22 patients completed the study in group II. The baseline variables like age and Results: sex were similar in both the groups with higher male predominance. There was no statistical signicant difference in tumor characteristics such as size, number and grade of the tumor between the two groups. Out of 22 patients in group I who underwent repeat TUR at 4 weeks of initial TUR, residual disease was found in 8 (36.36%) patients. One of the patient was found to have T2 disease and 1 patient had CIS during repeat TUR. These 2 patients were not followed up since the treatment strategy changed after the results of repeat TUR. After 6 months of follow up of all the patients, 2 (10%) out of 20 patients in group I were found to have tumor recurrence however, in group II, 9 (40.9%) patients had tumor recurrence. The tumor recurrence rate between the two groups was found to be statistically signicant (p=0.023). In the light of ndings of this Conclusion: study, it can be concluded that performing repeat transurethral resection in patients with newly diagnosed T1 bladder cancer at 4 weeks of initial TURBT, helps to detect signicant number of residual tumor and reduce early recurrence rate of the tumor.

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Analyses of the results in the treatment of locally advanced hypopharyngeal carcinoma with different therapeutic approach

Acta chirurgica iugoslavica ◽

10.2298/aci0901035m ◽

2009 ◽

Vol 56 (1) ◽

pp. 35-40 ◽

Cited By ~ 1

Author(s):

A. Mikic ◽

I. Pendjer ◽

Z. Dudvarski ◽

A. Trivic ◽

M. Kreacic

Keyword(s):

Neoadjuvant Chemotherapy ◽

Postoperative Radiotherapy ◽

Locally Advanced ◽

Group Iv ◽

Hypopharyngeal Carcinoma ◽

Group Iii ◽

Group I ◽

Primary Radiotherapy ◽

Group Ii ◽

Number Of Authors

Introduction: treatment of locoregional advanced hypopharyngeal cancers of grades III and IV would be surgery and/or radiotherapy. An increasing number of authors has emphasized favorable effects of neoadjuvant chemotherapy and radiotherapy with potentiation. The aim: the authors presented therapeutical results of three-year survived patients with squamocellular cancers of the hypopharynx (SCC Hy), grades III and IV, in relation to specific modalities of therapeutical approach. Methods: a series of 207 patients with grades III and IV of SCC Hy, treated in the period 1982 to 2002, was analyzed. Group I consisted of 131 patients who had surgery and postoperative radiotherapy (SUR-RT). Group II included 16 patients who underwent induction chemotherapy, surgery and postoperative radiotherapy (IC-SURRT). Group III consisted of 60 patients, who had primary radiotherapy (RT). Group IV involved 29 patients who were treated, in the period 2003-2006, by neoadjuvant chemotherapy followed by radiotherapy with potentiation (CHT-RT). Results: three-year survival in Group I was 67.94%, Group II - 50%, Group III - 30%, and in Group IV was 51.72%. Five-year survival was analyzed only in group IIII. The longest survival was observed in Group I - 33.59%. Conclusion: the best therapeutical results were achieved in patient group that was primarily operated on and then had postoperative radiotherapy, while the worst survival was recorded in patients who had primary radiotherapy.

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Good Operative Effects of Patellofemoral Arthroplasty Combined With the Tibial Tubercle Transfer for Isolated Patellofemoral Arthritis Patients With an Increased Tibial Tuberosity-Trochlear Groove Distance

10.21203/rs.3.rs-291693/v1 ◽

2021 ◽

Author(s):

Conglei Dong ◽

Chao Zhao ◽

Ming Li ◽

Huijun Kang ◽

Kang Piao ◽

...

Keyword(s):

Patellofemoral Joint ◽

Tibial Tuberosity ◽

Tibial Tubercle ◽

Trochlear Groove ◽

Patellofemoral Arthritis ◽

Patellofemoral Arthroplasty ◽

Group I ◽

Tibial Tubercle Transfer ◽

Group Ii

Abstract BackgroundThe objective of present study was to investigate the operative effect of patellofemoral arthroplasty combined with the tibial tubercle transfer for isolated patellofemoral arthritis patients with an increased tibial tuberosity-trochlear groove distance (>20mm). MethodsA prospective study was performed between November 2012 and December 2017. Finally, thirty-six cases, with a mean age of 61.1 ± 7.3 years, were admitted to our study. A total of 17 patients underwent patellofemoral arthroplasty combined with tibial tubercle transfer, and 19 patients underwent patellofemoral arthroplasty only. All eligible patients had CT scans preoperatively and at 12 months follow-up, to assess the stability of the patellofemoral joint on axial slices. In addition, the demographic and clinical features of all the patients were asked. Knee balance was assessed with the single leg stance test and timed get up and go, and functionality was evaluated with stair climbing test and the Western Ontario and McMaster Universities Osteoarthritis Index score. (P>0.05) ResultsPreoperatively, the data regarding the knee balance and functionality were not significantly different between the two Groups (P>0.05). Many measurements showed significant differences between the two groups at the last follow-up. Significant differences were seen in well-known measurements such as the SLST (Group I, 28.9 s (SD 7.5); Group II, 20.3 s (SD 5.9); p < 0.001), TGUG (Group I, 13.4 s (SD 3.2); Group II, 16.8 s (SD 3.1); p < 0.001), and SCT (Group I, 18.6 s (SD 6.8); Group II, 24.5 s (SD 8.7); p < 0.001). Additionally, the median WOMAC score was improved from 62.7 (SD 11.2) preoperatively to 25.7 (SD 8.2) one year postoperatively in Group I and from 64.1 (SD 10.7) to 36.2 (SD 9.7) in Group II, which were also significantly different between the groups. ConclusionsFor such special IPA patients with an increased TT-TG (>20mm), the combined operation of PFA combined with TTT can better restore the involutional relationship of patellofemoral joint and further improve the balance and function of knee joint.

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A Seven-year Follow-up Study of Patient Satisfaction with Three-implant-retained Mandibular Overdentures

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.5896 ◽

2021 ◽

Vol 9 (D) ◽

pp. 103-107

Author(s):

Hisham Samir ElGabry

Keyword(s):

Long Term Results ◽

Complete Dentures ◽

Patients Satisfaction ◽

Follow Up Study ◽

Group I ◽

Significant Difference ◽

Male Patients ◽

Group Ii ◽

Anterior Mandible

PURPOSE: This study aimed to compare patients’ satisfaction with mandibular overdentures retained by three-splinted implants versus conventional complete denture wearers during a 7-year follow-up study period. MATERIALS AND METHODS: Thirty edentulous male patients (mean age: 60 years) were carefully selected and divided into two equal groups. All patients received a new set of complete dentures. Group I patients received three implants in the anterior mandible and were connected after 3 months with bars, clips, and loaded. Group II patients received conventional complete dentures. Patients’ satisfaction was recorded for both groups at 3 weeks (baseline) and after 1, 3, 5, and 7 years. Patients were then asked to grade their overdentures/dentures on a visual analog scale and written questionnaire to evaluate their overall satisfaction. RESULTS: Satisfaction scores of Group I patients were found to be statistically significantly higher than that of Group II patients (p < 0.05) at 3, 5, and 7 years follow-up, meanwhile, no statistically significant difference was found at baseline or after 12 months. CONCLUSION: The long-term results suggest that three-implant-retained mandibular overdenture with a clip-bar attachment appears to be a successful rehabilitation strategy which is superior to conventional dentures for patients with advanced ridge resorption.

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Levobupivacaine in spinal anesthesia for primary knee and hip arthroplasty

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto202027131-35 ◽

2020 ◽

Vol 27 (1) ◽

pp. 31-35

Author(s):

K. Yu. Ukolov ◽

V. L. Ayzenberg ◽

M. V. Kapirina ◽

M. E. Mikitina

Keyword(s):

Elderly Patients ◽

Spinal Anesthesia ◽

Knee Arthroplasty ◽

Hip Arthroplasty ◽

Postoperative Nausea And Vomiting ◽

Anaesthetic Agents ◽

Group I ◽

Primary Knee Arthroplasty ◽

Group Ii ◽

Knee And Hip Arthroplasty

Introduction. Spinal anesthesia is widely used in major orthopedic. Primary hip and knee arthroplasty are major surgical procedures associated with significant potential morbidity in elderly patients. This increases requirement to surgical and anesthetic procedures. Some studies provide evidence that levobupivacaine when used as an alternative to bupivacaine in spinal anesthesia is less cardiotoxic and neurotoxic. Aim: To compare the efficacy and safety of these two spinal anaesthetic agents in elderly patients undergoing primary hip or knee replacement. Patients and methods. The study included 90 patients performed arthroplasty with spinal anesthesia. I group patients received spinal anesthesia bupivacaine 0,5%, II group patients received intrathecal levobupicavaine 0.5%. Group I (n=60), 22 (37%) underwent primary hip arthroplasty, and 38 (63%) patients that underwent primary knee arthroplasty with mean age (65,4 + 6,5). Group II (n=30), 18 (60%) patients that underwent primary total hip arthroplasty and 12 (40%) patients that underwent primary knee arthroplasty with mean age (65,5 + 8,1). Anesthesia algorithm did not differ for both groups. Results. Vital parameters and adverse effects in relation to spinal anesthesia were observed. Decrease of heart rate was more significant in group II. Blood pressure parameters were comparable to both groups though, 10% of Group I patients received infusion of norepinephrine for treatment of hypotension. The two groups were comparable with glucose and lactate variations as well as the duration of analgesia and postoperative nausea and vomiting. No postoperative delirium was noted in both groups. Conclusion. Spinal anesthesia with levobupivacaine is more safe for elderly patients undergoing knee and hip arthroplasty.

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Microsurgical C-2 ganglionectomy for chronic intractable occipital pain

Journal of Neurosurgery ◽

10.3171/jns.1998.89.3.0359 ◽

1998 ◽

Vol 89 (3) ◽

pp. 359-365 ◽

Cited By ~ 57

Author(s):

Andres M. Lozano ◽

Graham Vanderlinden ◽

Robert Bachoo ◽

Peter Rothbart

Keyword(s):

Axonal Regeneration ◽

Excellent Result ◽

Spontaneous Pain ◽

Content Type ◽

Group I ◽

Experienced Pain ◽

Pain Outcome ◽

Group Ii ◽

Fine Print

Object. The authors evaluated the effectiveness of microsurgical C-2 ganglionectomy in 39 patients with medically refractory chronic occipital pain. In this procedure the neurons transmitting sensory inputs from the occiput are removed and, unlike peripheral nerve ablation, axonal regeneration is not possible. Methods. The patients in this series had symptoms for 1 to 43 years. In 22 patients the occipital pain was caused by trauma; in 17 patients the pain was spontaneous. Pain relief failed in 17 patients who had undergone a previous occipital neurectomy or C-2 rhizolysis. Twenty-three patients experienced pain that was described as shocklike, electric, shooting, jabbing, stabbing, sharp, or exploding (Group I). Eight patients described their pain as dull, pounding, aching, throbbing, or pressurelike (Group II). The patients underwent unilateral or bilateral C-2 open microsurgical ganglionectomies. The postoperative follow-up period ranged from 19 to 48 months. Nineteen patients experienced an excellent result (> 90% reduction in pain). Pain caused by trauma or that described using Group I terms responded best to ganglionectomy (80% good or excellent response). In contrast, the majority of the patients with nontraumatic pain or those described using Group II descriptors did not achieve favorable results. Conclusions. The authors conclude that: 1) patients who suffer from chronic occipital pain after having sustained injury obtain worthwhile benefit from microsurgical C-2 ganglionectomy; 2) patients suffering from migraine, tension, and vascular headaches involving the occipital area are most often not helped by this operation; and 3) terms such as “shock,” “electric,” “shooting,” “jabbing,” and “sharp” used to describe occipital pain predict a favorable pain outcome following a C-2 ganglionectomy.

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Evolving Solutions in the Surgical Treatment of Isolated Pulmonary Valve Stenosis

10.37191/mapsci-jccr-2(3)-044 ◽

2021 ◽

Author(s):

Sonia B. Albanese Albanese

Keyword(s):

Surgical Treatment ◽

Pressure Gradient ◽

Pulmonary Valve ◽

Balloon Valvuloplasty ◽

Pulmonary Valve Stenosis ◽

Group I ◽

Mean Pressure ◽

Valve Function ◽

Group Ii

Background: Surgical treatment of isolated pulmonary valve stenosis in infants and children has evolved over the years, shifting from the original exclusive aim at lowering right ventricle pressure to the current concomitant focus on preserving pulmonary valve function. In our study, we sought to analyze the effect of such evolving philosophy on long-term results. Methods: All consecutive patients treated in our center between July 1983 and March 2019 were included. Patients were categorized into 2 groups based on the introduction into treatment practice of sparing valve techniques (1995). Actuarial survival, freedom from reintervention on the right outflow tract, transvalvular mean pressure gradient decrease, and pulmonary valve function at follow-up were analyzed. Results: One hundred twenty-three patients operated before (Group I, n=81) or since (Group II, n=42) 1995 were enrolled in the study. Mean age and weight were 3.0 ± 0.36 years and 16.6 ± 1.7kg, respectively. Early mortality occurred exclusively in 3 patients of Group 1. Transvalvular mean pressure gradient decreased in the entire patient population (from 63.28 ± 12.9mmHg to 16.46 ± 7.9mmHg). At a mean follow-up interval of 4.9 ± 33 years, freedom from death was comparable, but freedom from right ventricular outflow tract reintervention was significantly greater in Group II. Although the transvalvular gradient remained stable over time in non-reoperated survivors (mean value of 16.46 ± 7.9mmHg), pulmonary valve function on 2D-Echo showed severe incompetence in 2 patients of Group I and just mild to moderate incompetence in 20 patients of Group II, with a significantly negative effect of unsuccessful preoperative pulmonary balloon valvuloplasty (14/20 vs 6/20, p=0.025) in the latter. Conclusion: Current pulmonary valve sparing techniques are associated with better results, particularly in terms of freedom from re-interventions and pulmonary valve function at follow-up. Balloon valvuloplasty prior to surgery may worsen operative results, promoting pulmonary insufficiency and therefore should probably be avoided in all patients in whom anatomical characteristics predict failure of percutaneous therapy.

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